Terlipressin

How it works

It is a prodrug slowly converted to lysine-vasopressin and acts on vascular V1 receptors to produce splanchnic and systemic vasoconstriction, reducing portal venous pressure and variceal blood flow.

Prescribing in practice

• Its vasoconstrictor action can precipitate myocardial, mesenteric, cerebral or peripheral ischaemia, so avoid or use with great caution in ischaemic heart disease, peripheral vascular disease and uncontrolled hypertension, and monitor for ischaemic events.
• It can cause hyponatraemia, so sodium should be checked, and caution is needed in asthma, respiratory failure and septic shock where worsening outcomes have been reported.
• Use with care in the elderly and in pregnancy (it can reduce uterine blood flow and induce contractions).

Monitoring

Monitor blood pressure, heart rate and rhythm, fluid balance, serum sodium, and the colour and perfusion of the extremities for signs of ischaemia.

Counselling the patient

• Explain this drug is given by drip or injection to reduce bleeding from the gut.
• Report chest pain, abdominal pain or cold, painful or discoloured fingers or toes.

Evidence & guidelines

Its use in variceal bleeding and hepatorenal syndrome is supported by randomised trials and endorsed in UK and international hepatology guidance.